Prevalence and factors affecting home blood pressure documentation in routine clinical care: a retrospective study

Abstract

Background: Home blood pressure (BP) is closely linked to patient outcomes. However, the prevalence of its documentation has not been examined. The objective of this study was to analyze the prevalence and factors affecting documentation of home BP in routine clinical care.

Methods: A retrospective study of 142,973 encounters of 9,840 hypertensive patients with diabetes from 2000 to 2005 was performed. The prevalence of recorded home BP and the factors associated with its documentation were analyzed. We assessed validity of home BP information by comparing the difference between home and office BP to previously published prospective studies.

Results: Home BP was documented in narrative notes for 2.08% of encounters where any blood pressure was recorded and negligibly in structured data (EMR flowsheets). Systolic and diastolic home BP in narrative notes were lower than office BP readings by 9.6 and 2.5 mm Hg, respectively (p < 0.0001 for both), consistent with prospective data. Probability of home BP documentation increased by 23.0% for each 10 mm Hg of office systolic BP (p < 0.0001), by 6.2% for each $10,000 in median income of zip code (p = 0.0055), and by 17.7% for each decade in the patient's age (p < 0.0001).

Conclusions: Home BP readings provide a valid representation of the patient's condition, yet are seldom documented despite their potential utility in both patient care and research. Strong association between higher patient income and home BP documentation suggests that the cost of the monitors may be a limiting factor; reimbursement of home BP monitoring expenses should be pursued.

Figure 1

Systolic Blood Pressure By Type of Blood Pressure Reading Systolic Blood Pressure By Type of Blood Pressure Reading Office and home SBP readings from 2,060 encounters with a home blood pressure reading were compared. Wisps indicate standard error. b) Diastolic Blood Pressure By Type of Blood Pressure Reading.

Figure 2

Office Systolic Blood Pressure vs. Frequency of Home Blood Pressure Reporting Office Systolic Blood Pressure vs. Frequency of Home Blood Pressure Reporting Frequency of documentation of home blood pressure in narrative notes was plotted against the lowest office systolic blood pressure from either narrative notes or structured flowsheets on the day of the encounter. Wisps indicate 95% confidence interval.